American Legal Nurse Consultant Certification Board

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					State of the State 2010 APRN Practice
            Sue LaMotte, RN, CNM, MS
     MN NP/CNM Student Conference
                    February 26, 2010
    Keys to a Successful Transition into
 Advanced Practice Registered Nursing

Everything You Ever Wanted to Know
        About APRN Regulation
                               Susan E. LaMotte, RN, CNM, MS
                           Advanced Practice Nursing Consultant
                                    Minnesota Board of Nursing

Current State
  Statute Language
  APRN Data

Consensus Model for APRN
APRN Consensus Model Task Force

 1983                            1988                         1990                  1994                1999

                                                             NPA added 148.235
                    Nurse Practice Act                                                                 Extensive revision
                                                            (prescribing section)
Language defining   (148.171 – 148.285)   NP and Psych/MH                                                  of NPA; all
                                                                  Added NP
CNM and CRNA in     added definition of    CNS definition                           Psych/ MH CNS      definitions in law
                                                                definition and
 Health Insurance        CNM and               added                                added to 148.235      now outlined
  Statutes (62A)        prescribing           to 62A.15                                                      In NPA
Current State
Mission Statement
   …to protect the public’s health and safety
   by providing reasonable assurance that the
   people who practice nursing are
   competent, ethical practitioners with the
   necessary skills appropriate to their title
   and role
                         The Nurse Practice Act

 Authorizes APRN practice
   Licensed as RN
   Current certification on APRN Registry
 APRN is independently accountable for practice
 Language is very broadly written
   Does not detail specifics of scope of practice
   Look to professional bodies, certification
    organizations, ANA Standards, etc

―Advanced practice registered nurse, abbreviated APRN, means an
  individual licensed as a registered nurse by the board and certified
  by a national nurse certification organization acceptable to
  the board to practice as a:

               clinical nurse specialist,
               nurse anesthetist,
               nurse-midwife, or
               nurse practitioner
                                            Minnesota statutes, section 148.171, subd 3
                      Definition                  Continued

The practice includes functioning as a:
        direct care provider,
        case manager,
        educator, and
                    Minnesota statutes, section 148.171, subd. 13
                    Definition                Continued

The APRN must practice within a health
    care system that provides for:
    collaborative management, and

                       Minnesota statutes, section 148.171, subd. 13
                                             CNP Practice

…means, within the context of collaborative

(1) diagnosing, directly managing, and preventing acute
  and chronic illness and disease; and
(2) promoting wellness, including providing
  nonpharmacologic treatment.
The NP is certified in a specific field of clinical

                                    Minnesota statutes, section 148.171, subd. 11
               Collaborative Management

…is a mutually agreed upon plan between an
 APRN and one or more physicians… that
 designates the scope of collaboration necessary
 to manage the care of patients.

The APRN and the physician must have
  experience in providing care to patients with the
  same or similar medical problems…

                            Minnesota statutes, sections 148.171, subd. 6

…..does not apply to an advanced practice
  registered nurse who is within six
  months after completion of an advanced
  practice registered nurse course of
  study and is awaiting certification,
  provided that the person has not
  previously failed the certification exam

                          Minnesota statutes, section 148.284
           National Nurse Certification
 American Academy of Nurse Practitioners
 American Association of Critical-Care Nurses
  Certification Corporation
 American Nurses Credentialing Center
 American Midwifery Certification Board
 Pediatric Nursing Certification Board
 National Certification Corporation for Obstetric,
  Gynecological, and Neonatal Nursing Specialties
 Council on Certification of Nurse Anesthetists
                                                                                   APRN Registry
               Current registration    Current registration    Current registration    Current registration    Current registration
                     and expired             and expired             and expired             and expired            and expired
   APRN             certification as        certification as        certification as        certification as        certification as
                       of 6/2006               of 1/2007            of 10/31/2007            of 7/31/2008           of 9/21/2009

CRNA                           461                     358                    396                     174            392(21.7%)

CNM                              22                      20                     10                      13              11 (4.7%)

CNP                            370                     308                    298                     230           353 (12.4%)

CNS                              77                      88                     82                      53            88 (14.8%)

Total                          930                     774                    786                     470           844 (15.4%)
                            APRN Registry

Practicing without current certification or
  failure to notify Board of current
  certification is subject to payment of a
  penalty fee:

            $200 first month
      $100 each subsequent month
                                                                   MN APRNs Today

                                 Advanced Practice Registered Nurses on Registry











             FY 2000   FY 2001     FY 2002   FY 2003   FY 2004   FY 2005   FY 2006   FY 2007   FY 2008   FY 2009   YTD 2010
APRN total    2046      2688        3208      3405      3550      3401      3823      4218     4,608     4,429      4,651
CNP           1101      1347        1492      1565      1662      1721      1922      2212     2,332     2,406      2,386
CNS           204       284         370       409       429       447       442       486       494       515        510
CRNA          640       927         1182      1071      1278      1046      1268      1305     1,564     1,290      1,537
CNM           101       130         164       173       181       187       191       215       218       218        218
                                     APRNs Today

           APRN by Categories 2009





Delegated medical function (exception:

Memorandum of Understanding
 Created by MNA and MMA
  Identifies elements required for written

                              Minnesota statutes, section 148.235
                         DEA Number

Two Step Process
Application to the DEA
Submit to the Board:
  Verification of Compliance form with
   the requirements
  $50 fee
  Copy of certificate as APRN

An advanced practice registered nurse …….. shall use
  the appropriate designation:
    RN,CNS
    RN,CNM
    RN,CNP
    RN,CRNA

for personal identification and in documentation of services
   provided. Identification of educational degrees and
   specialty fields may be added.
                                          Minnesota statutes, section 148.233 subd 2
        On the National Front

Consensus Model
APRN Regulation
                            Reasons for a
                       Future APRN Model

 Lack of common definitions related to APRN
 Lack of standardization in programs leading
  to APRN preparation
 Proliferation of specialties and subspecialties
 Lack of common legal recognition across

NCSBN APRN Committee                  APRN Consensus Process
(formerly Advisory Group)                50 Organizations

                                           APRN Consensus
                                              Work Group
                                            23 Organizations

               Joint Dialogue Group
                                     Consensus Model for
                                        APRN Regulation
APRN regulation includes:
   Licensure
      • The granting of authority to practice
   Accreditation
      • Formal review and approval by a recognized agency of
        certification agencies and APRN education programs
   Certification
      • The formal recognition of knowledge, skills and experience
        demonstrated by the achievement of standards identified by the
   Education
      • The formal preparation of APRNs in graduate or post-graduate

          Implementation target date: 2015

 Second license as APRN: CRNA, CNM, CNS, CNP
 Regulated solely by Boards of Nursing
 Independent practitioners, including prescribing
 APRN Licensure Compact
 National certification
 Graduate level education with program
 ―Grandfathering‖ clause

 Meet standards

 Educational program includes: APRN Core, Role
  Core and Population Core

 Graduate or Post-Graduate level

 Must grant pre-approval, pre-accreditation, or
  full accreditation prior to student enrollment

 Monitor

 Certifying bodies must be accredited

 Follow standards for testing

 Test APRN Core, Role Core and at least one
  Population Core

 Specialty competency will be separate

 Foundation:
    APRN core – the 3 Ps
    Role core (4 categories)
    Population core:
      P/MH
         Gender Specific
         Adult-Gerontology
         Pediatrics
         Neonatal
         Family/Individual Across Lifespan
 Pre-Approved and national accreditation
                                                      APRN Regulatory Model
                                                                           APRN Specialties
                                                            Focus of Practice beyond role and population focus
                                                                        Linked to health care needs
                                                       Examples include but are not limited to: Oncology, Older Adults,
                                                           Orthopedics, Nephrology, Palliative care, Critical Care
Licensure at levels of role and

                                                                        POPULATION FOCI

                                  Family/Individual     Adult-         Women’s Health/                                             Psych/Mental
                                                                                              Neonatal           Pediatrics
                                   Across lifespan    Gerontology      Gender Related                                                 Health
      population foci

                                                                          APRN ROLES

                                        Nurse                   Nurse                      Clinical Nurse                   Nurse
                                      Anesthetist               Midwife                      Specialist                   Practitioner
APRN Consensus Model
    Task Force
                                APRN Consensus Model
                                          Task Force

 Commissioned by Board at June 2009 meeting
 Representation of all categories
   Geographical representation
 Charge: ―Compare NPA to the Consensus Model to
  identify implications for Minnesota‖
 Final report presented to Board at February, 2010
 The ―quandry‖

 The APRN Task Force asserts that
       implementation of the
Consensus Model for APRN Regulation
    would enhance public safety
                             Next Steps

The APRN Consensus Model Task Force
           will reconvene to make
  recommendations for implementation,
     with consideration for incremental
    change. Each recommendation will
    include differentiation between the
   benefit to public safety and advocacy
             for APRN practice.
Expanding Scope
   of Practice
                                           Changes in
                               Healthcare Professions’
                                     Scope of Practice
1. The purpose of regulation — public protection —
   should have top priority in scope of practice
   decisions, rather than professional self-interest.
2. Changes in scope of practice are inherent in our
   current healthcare system.
3. Collaboration between healthcare providers should
   be the professional norm.
4. Overlap among professions is necessary.
                                                         Association of Social Work Boards (ASWB)
                                          Federation of State Boards of Physical Therapy (FSBPT)
                                                        Federation of State Medical Boards (FSMB)
                                National Board for Certification in Occupational Therapy (NBCOT®)
                                       National Council of State Boards of Nursing, Inc. (NCSBN®)
                                             National Association of Boards of Pharmacy (NABP®)
                      Expanding Scope of Practice

The argument for scope of practice changes should have a
  foundational basis within four areas:
   1) an established history of the practice scope within
     the profession,
   1) education and training,
   1) supporting evidence, and
   1) appropriate regulatory environment

 “You must be the
change you wish to
 see in the world”
              Mohandas Gandhi

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